Basic Information
| Provider Information | |||||||||
| NPI: | 1205938669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRENSHAW | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHD ABPP CST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRENSHAW | ||||||||
| OtherFirstName: | WES | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PHD ABPP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICE LLC | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 0894 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 100353150 A | 05 | KS | MEDICAID | 119046 | 01 | KS | BCBS OF KS | OTHER |